Prehospital cardiopulmonary resuscitation duration and neurological outcome after adult out-of-hospital cardiac arrest by location of arrest

Abstract

Background Little is known about the association between prehospital cardiopulmonary resuscitation duration for adults with out-of-hospital cardiac arrest and outcome by the location of arrests. This study aimed to investigate the association between prehospital cardiopulmonary resuscitation duration and one-month survival with favourable neurological outcome. Methods We analysed 276,391 adults aged 18 years and older with out-of-hospital cardiac arrest of medical origin before emergency medical service arrival. Prehospital cardiopulmonary resuscitation duration was defined as the time from emergency medical service-initiated cardiopulmonary resuscitation to prehospital return of spontaneous circulation or to hospital arrival. The primary outcome was one-month survival with favourable neurological outcome (cerebral performance category 1 or 2). The association between prehospital cardiopulmonary resuscitation duration and favourable neurological outcome was assessed using univariable and multivariable logistic regression analyses. Results The proportion of favourable neurological outcomes was 2.3% in total, 7.6% in public locations, 1.5% in residential locations and 0.7% in nursing homes ( P < 0.001). In univariable and multivariable logistic regression analyses, longer prehospital cardiopulmonary resuscitation duration was associated with poor neurological outcome, regardless of arrest location ( P for trend < 0.001). Patients with shockable rhythm in both public and residential locations had better neurological outcome than those in nursing homes at any time point, and residential and public locations had a similar neurological outcome tendency among patients with shockable rhythm. Conclusions Longer prehospital cardiopulmonary resuscitation duration was independently associated with a lower proportion of patients with favourable neurological outcomes. Moreover, the association between prehospital cardiopulmonary resuscitation duration and neurological outcome differed according to the location of arrest and the first documented rhythm.

Unfavorable Neurological Outcomes with Incremental Cardiopulmonary Resuscitation Duration in Cardiac Arrest Brain Injury: A Systematic Review and Meta-Analysis

“…A total of 4 studies were included in our meta-analysis [6][7][8][9]. Of them, we had 2 retrospective and 2 prospective cohort studies (1 from the United States, 1 from Europe, and 2 from Japan).…”

The hospitalised out-of-hospital cardiac arrest patient: We need more research

“…In this issue, Kishimori et al reported that only 2.3% of 276,391 adults with OHCA in Japan survived with a favourable neurological outcome. 2 Beyond discussion, increased resuscitation attempts from both lay persons and professional caregivers in the prehospital setting can improve survival rates, but improved in-hospital care of the resuscitated OHCA patient is another important target. Intensivists and cardiologists have a common obligation here: do more research to improve outcome of the hospitalised OHCA patient.…”